In 2020 being a member of a medical team is many times like a high stakes game of whack-a-mole. When one issue gets under control, another issue pops up, and we have to bop that next one on the head and then look for another one to pop up. People today may have five or six serious medical issues. It is not uncommon to see individuals that are overweight with high blood pressure, heart disease and diabetes, and each one of those medical issues can spawn many other concerns. That may even be the norm now. When members of a medical team look at individuals, they now have to prioritize problems that need to be dealt with. Being overweight has been identified as an independent risk factor for hypertension, heart disease, and diabetes, which means that just being overweight alone can significantly increase your chances of developing severe medical conditions like hypertension, heart disease, or diabetes. In food and beverage, we call that a critical control point where attention to one thing can help solve a whole bunch of problems at one time. In my opinion, reducing weight warrants a place at the top of just about every individual’s medical issue priority list. Shedding some weight is like whacking ten moles at one time; it is that important!
The problem is that losing weight ain’t easy! Everybody and every body is different. What works for one person will not necessarily work for another, and even what works one time for a specific individual will change over that individual’s lifetime. What we did to lose and maintain weight in our twenties is not going to work when you hit forty or fifty years old.
That’s why no diet is right for absolutely every person on the planet. As I mention over and over again, the weight loss plan you choose needs to be based on your willingness and ability to change, given what is going on in your life at a particular moment in time. I am going to add one more thing here; it also needs to be based on your medical issue priority list as well. Remember that dieting is a short-term exercise producing results that are almost always temporary, and lifestyle modification is a long-term plan that produces lasting weight loss results as a byproduct of returning your body to health. If losing weight is at the top of your medical issue priority list, then doing whatever is required to get that weight off is what needs to be done. Let’s be 100 percent clear here, losing ten vanity pounds does not place weight loss at the top of your medical issue priority list! People that are forty to one hundred and forty pounds overweight or more may need to consider weight-loss strategies that the rest of the population do not. Sadly, according to a study published in the December 2019 issue of The New England Journal of Medicine, right here in Kansas, 55.6% of the population is projected to have a body mass index over 30 in 2030. BMI categories are normal weight (18.5 to 25), overweight (25 to 30), and obese (over 30). So, more than half of the future population of the state we live in will need to consider weight loss as a medical issue priority. That changes the landscape in terms of choosing between a diet or lifestyle modification.
I talk about a spectrum of healthy diets quite a bit. I try not to mention specific diets except to identify the DASH diet (dietary approaches to stop hypertension) as the most effective diet on the moderate side of the spectrum and the plant-based whole foods diet as the most effective diet on the aggressive side of the spectrum. Both of these diets have been very well studied and results published in many peer-reviewed medical journals. They are both safe and effective. I stay away from commenting about diets that are extreme. The vegan, low-fat diet is extreme for most people, and although it is 100 percent safe for people that know what to eat, only a tiny percentage of people know what to eat or are willing to learn. Low-carbohydrate diets are another diet I seldom comment on because it is physiologically counterintuitive and can be dangerous. That has been my opinion, but now it is rising to the level of consensus among researchers and scientists. I can already hear some readers groaning, so let me make one clarification. Low-carb diets are highly effective in the short term, but there are many high-quality studies showing that results are most often temporary. If you are in a situation where weight loss is at the top of your medical issue priority list, then you may want to consider a low-carb diet.
Modern low-carb diets were all born out of the Atkins diet made popular in 1972. Later, modified versions of the Atkins diet include the Zone Diet, the South Beach Diet, the Paleo Diet, and the Ketogenic or Keto diet. They are all based on reduced carbohydrate intake. There are some earlier low-carb advocates, but Atkins put it on the modern map.
Remember from last week that carbohydrates are sugars and starches, also known as saccharides. They represent the primary food source for most living things on the planet. There are various types of carbohydrates. They include monosaccharides, disaccharides, and polysaccharides. One type of polysaccharides is glycogen. Glycogen is the way that animals, including humans, store energy. Glycogen is the fat we all see on our bodies.
Carbohydrates are broken down into monosaccharides, one of which is glucose. Our bodies want to burn glucose as fuel. In the absence of glucose, we go to carbohydrates stored as glycogen or fat. Ketones are created when fat is metabolized, and that is what our cells use as fuel when there is no glucose around. Neurons in our brains can also use ketones as fuel. This is a daily occurrence. When we sleep, blood glucose levels drop and ketones are made from fat for our cells to use. This is fine except for people with diabetes. A hazardous condition called diabetic ketoacidosis is created when there are too many ketones in the blood. It is mostly an issue for type 1 diabetics, but those with type 2 diabetes and even insulin resistance can be affected. If you are the one in ten Americans that have diabetes or the one in three that is insulin resistant and prediabetic, reducing carbs as a way to diet can be dangerous. There is always a disclaimer at the bottom of this healthy eating tip that encourages everybody to consult a doctor before going on a diet. This is one reason to do that! Ketosis is the state the body is in when it burns fat and creates ketones. It is often confused with ketoacidosis, which is a dangerously high level of ketones in the blood.
This is one reason to be cautious with a low-carb diet and that affects between 10 and 33 percent of Americans.
A presentation at the European Society of Cardiology Congress recently caught my eye. It is based on both a new analysis of the National Health and Nutrition Examination Survey (NHANES) involving 24,825 participants and a meta-analysis of pooled data from nine prospective cohort studies with 462,934 participants. A meta-analysis is an extremely powerful research tool used to determine if “consensuses” has been achieved. It is a separate study of the results of many other studies compiling extremely large sets of data. Remember that “consensus” is a general agreement among the members of the scientific community about something. The National Health and Nutrition Examination Survey (NHANES) is a program of studies designed to assess the health and nutritional status of adults and children in the United States. The survey is unique in that it combines interviews and physical examinations.
Data from the new NHANES analysis of 24,825 people showed that those with the lowest carbohydrate intake had a 32 percent higher risk of death from any cause, a 50 percent higher risk of death from cardiovascular disease, a 51 percent higher risk of death from a cerebrovascular event and a 36 percent higher risk of cancer mortality. The meta-analysis findings of pooled data of nine prospective cohort studies with 462,934 participants indicated an increased risk of death from all causes, 8.6 percent increased risk of death from cardiovascular disease, 11.2 percent increased risk of cancer mortality, 10.3 percent also from those with the lowest carbohydrate intake.
Although the authors of the analysis state that the “biology that underlies the positive association between low-carbohydrate diets and all-cause death is not fully elucidated,” they do postulate some potential mechanisms and what they come up with makes perfect intuitive sense!
They suggest that the reduced intake of fruits, vegetables, whole grains, fiber and the associated reduction in vitamins and phytochemicals along with the increased intake of protein from animal sources, cholesterol and saturated fat, all of which are risk factors for cardiovascular disease, cerebrovascular event, and cancer may be mechanisms for the study results. “Further, it has been proposed that vegetables, fruits, cereals and legumes, which have been found in several studies to be core components of healthy dietary patterns,” but missing from the low-carb diet must be a contributing factor. “Reduced intake of these food groups is likely to have adverse effects on cardiovascular health.”
The authors further state that “high intake of protein from animal sources may essentially increase the risk of cardiovascular disease whereas high fiber diets appear to be associated with better long-term outcomes.”
In their typical cautious fashion, the authors of the study refused to make a statement of direct causation. They state that there is an “association” between low carbohydrate diets and increased mortality, and this “may suggest a need to rethink recommendations for low carbohydrate diets in clinical practice.”
We will discuss how all of this can help us choose “what to eat for supper tonight” in the next Healthy Eating Tip!
Eat Well – Be Well!
Here are the references for today’s Healthy Eating Tip:
Ward ZJ, et al. Projected U.S. State-Level Prevalence of Adult Obesity and Severe Obesity. New England Journal of Medicine. 2019;381;(25):2440-2450.
Centers for Disease Control and Prevention. Diabetes. Resources and Publications. Features and Spotlights. National Diabetes Statistics Report, 2020. https://www.cdc.gov/diabetes/library/features/diabetes-stat-report.html. (Accessed 8/20/2020.)
Mazidi M, Katsiki N, Mikhailidis DP, Sattar N, Banach M. Lower carbohydrate diets and all-cause and cause-specific mortality: a population-based cohort study and pooling of prospective studies. European Heart Journal. 2019;40(34):2870-2879.